2018 MIDTERM ELECTION

HealthSource RI, Rhode Island's ACA exchange, released preliminary 2018 Open Enrollment data awhile ago, but this morning they released their final, official demographic data breakout, and there's a lot going on here:

Under the Guise of “Health Insurance Stabilization,” Congress Should Not Axe Financial Help for Low-Wage Families

In negotiations over stabilizing the individual health insurance market, lawmakers are considering slashing federal health care assistance for low- and moderate-income consumers by more than $27 billion a year. In dollars terms, this would be a greater blow than completely eliminating, in one stroke, the Low-Income Home Energy Assistance Program, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the Child Care and Development Block Grant, the Community Development Block Grant, and federal grant programs for community-based mental health services and substance abuse prevention and treatment.

Health insurers and the Trump administration face a court decision shortly that will determine whether the government must pay insurers billions of dollars despite Republican efforts to block payments they view as an industry bailout.

Insurers have filed roughly two-dozen lawsuits claiming the federal government reneged on promises it made to pay them under the Affordable Care Act.

...It could also shape the outcome of other insurer lawsuits that would leave the government potentially owing as much as roughly $20 billion in past and future payments. Those cases, legal experts say, amount to the largest civil lawsuits ever.

Between the lines: This doesn't solve the partisan dispute over abortion language, as it'd bar plans that offer abortion coverage from receiving federal subsidies. But it hints that there's Republican support behind a set of policy changes that could substantially lower premiums ahead of the 2018 elections.

I wrote an extensive piece about the way abortion coverage is currently handled for ACA exchange policies back in October 2017:

Yesterday I came out against the pending ACA stability package because one of the 5 proposed provisions should be a flat-out dealbreaker for Democrats (the abortion ban), while another one is would hurt more people than it helps (CSR funding).

Today, I need to explain the problem with CSR funding in a bit more detail but to also note a new twist which makes it even more complicated...as well as taking note of a sixth provision being thrown into the mix by the GOP which, again, should be a dealbreaker for Democrats.

First up: CSR funding.

I'm on the record as being strongly in favor of a bill recently proposed by House Democrats Frank Pallone, Jr., Richard Neal and Bobby Scott which would repair, strengthen and expand the ACA in a half-dozen ways while also preventing or reversing another half-dozen types of sabotage of the ACA by the Trump Administration. Here's the full list of what would be included in what I've shorthanded "ACA 2.0":

As long as I'm snarking on Washington's exchange for getting so excited over what appear to be pretty minor tweaks (to the average Joe, anyway), I might as well also give a shout-out to Connect for Health Colorado as well, which just posted this tidbit:

To Our Valued Stakeholders,

We took an important step forward this week with our board’s decision to move ahead on building a new eligibility system. With our own system, we will be able to provide customers a better application and enrollment experience and at the same gain more control and predictability for IT expenses.

A simplified path for enrolling with financial help can be expected to help us grow enrollment while getting more Coloradans the Advance Premium Tax Credit and Cost Share Reduction benefits that they are eligible to receive. We will continue to support Health First Colorado (Medicaid) enrollments and ensure that customers are routed to the right program, whether they begin at our site or with the PEAK application.

Sens. Lamar Alexander and Susan Collins have proposed a market stabilization package that would include funding for the Affordable Care Act's cost-sharing reduction subsidies for three years, three years of federal reinsurance at $10 billion a year, additional ACA waiver flexibility for states, and expanded eligibility for "copper" plans.

Alexander presented the plan yesterday to America's Health Insurance Plan's board of directors, adding that if Democratic leadership supports the bill, “it’ll be law by the end of next week." Alexander has long said the package should be included on the omnibus spending bill.

Public Policy Polling conducted a telephone exit poll election survey of voters who cast ballots in Pennsylvania’s 18th Congressional District special election yesterday. Voters who voted in the contest were asked about the role of health care in their decision.

The exit poll shows that health care was a top priority issue to voters in this district and that voters believed Democrat Conor Lamb’s views were more in step with theirs.

In 2016, voters in this district backed Donald Trump by 20 points, but last night they backed a Democrat for Congress in a referendum on the health care plans of the Republican Congress:

Wisconsin Senator Tammy Baldwin has been on a bit of an "Improve the ACA" tear lately. A couple of weeks ago she introduced the "Fair Care Act" to try and nip Donald Trump's #ShortAssPlans proposal in the bud. Now she's introduced another bill which would help shore up the ACA exchanges themselves: The "Advancing Youth Enrollment Act" via Kimberly Leonard of the Washington Examiner):

The Advancing Youth Enrollment Act would give higher federal subsidies to people between the ages of 18-34 so that the cost of private Obamacare plans for them would be lower.

...Under the proposal, young adults would see the maximum percentage of income they must pay toward health insurance under Obamacare decrease by 2.5 percentage points for people between the ages of 18 to 30. Each year after, until the age of 34, they would see a gradual phaseout of 0.5 percentage points a year.

“This state-level legislation protects important progress made in Washington state under the Affordable Care Act. Our position as the state’s health insurance gateway is now stronger than ever, and despite continued uncertainty we may see at the federal level, this bill enables us to continue improving the customer experience for the people in our state.

I should note up front that despite the snarky headline, this is actually good news on the whole, and Premera does deserve some credit for it since part of the $250 million they refer to below is voluntary on their part.

Premera Blue Cross, the sole carrier offering ACA exchange individual market policies throughout the entire state of Alaska, and one of the major carriers on the indy market in Washington State, posted this press release today:

Premera Announces $250 Million Investment In Customers and Community

Mountlake Terrace, Wash. — (March 12, 2018) — Premera Blue Cross, a leading health plan in the Pacific Northwest, today announced $250 million in investments over five years across Washington and Alaska to help stabilize the individual market, improve access to care in rural areas and support local communities in their efforts to address the behavioral health issues impacting their residents.

Alabama, which has refused to expand Medicaid for low-income adults under the Affordable Care Act (ACA), is now proposing to make work a condition of Medicaid eligibility for very low-income parents, stating that it wants to encourage work. Its proposal, however, actually would penalize work: because Alabama hasn’t expanded its program, those who comply with the new requirements by working more hours or finding a job will raise their income above the state’s stringent Medicaid income limits, thereby losing their Medicaid coverage and likely becoming uninsured.

To be honest, I'm not entirely sure I understand why Idaho would do this. Yes, of course the deep red state government opposes the ACA in general and sure, they want to "lower premiums" on the individual market, but Trump's recent "ShortAss Plan" executive order would do pretty much the same thing(allowing non-ACA compliant off-exchange "Short Term/Association Plans" which amount to the same thing...without putting GOP Gov. Butch Otter's fingerprints all over the ugly stories which would soon follow if/when people started actually enrolling in these types of policies. Besides, as much as Idaho claims to hate the ACA, they seem to be quite proud (and rightly so) of their own state-based ACA exchange, Your Health Idaho.

Well, it sounds like CMS Administrator Seema Verma was thinking along the same lines, because this unexpected story broke a few hours ago: Verma sent a letter to Otter and his state Insurance Commissioner shooting down their "state-based plans" idea as being flat-out illegal.

Sen. John Barrasso, R-Wyo., introduced legislation Wednesday that would let more people enroll in short-term health insurance plans, an idea that builds off a Trump administration proposal issued last month.

The Improving Choices in Health Care Coverage Act would allow people to stay on less expensive, short-term medical plans for as long as 364 days and allow them to renew for subsequent years.

Today, Covered California issued a new study about the projected impact of Donald Trump and Congressional Republican efforts to undermine and sabotage the Affordable Care Act not just in 2019, but over the next 3 years. They main focus is on two sabotage moves which have already happened (repeal of the individual mandate and the shortened/underfunded marketing of the open enrollment period on the federal exchange) and one which is on the verge of happening (Trump's "Short Term and Association Plan" executive order, aka #ShortAssPlans).

I've written a lot about Idaho's decision to simply ignore ACA regulations by allowing non-ACA compliant healthcare policies which would destabilize the individual healthcare market even worse than it already is today.

But it would be a mistake to ignore what Idaho is up to. If the Trump administration doesn’t intervene, other red states will surely follow in its footsteps. The result will be widespread disregard of the law and the rise of state-to-state inequalities in the private market similar to those that already exist in Medicaid.

Every day I'm overwhelmed with so many important healthcare policy stories that I don't have time to do a full write-up on them all. Usually I just skip past most, but once in awhile I like to do quick posts on a bunch at a time.

Most people try to avoid reading their health insurance policies — that’s what employers and insurance agents are for. Anyone who plans to buy short-term health insurance, though, will need to read the policy carefully.

The Trump administration recently announced plans to allow consumers to buy short-term health insurance plans that last for up to a year. They are currently capped at 90 days.

Thanks to Twitter follower "@tweetmix" for bringing this to my attention.

Back in late January, I noted that while the ACA's Shared Responsibility Penalty (aka the Individual Mandate) was repealed by Congressional Republicans back in December, ithe repeal doesn't actually go into effect until spring 2020 (for lacking coverage in 2019). For 2017 and 2018, it's still on the books...and the IRS has stated point-blank that they will be rejecting tax returns that don't include a statement of ACA-compliant coverage. This, I noted, is going to piss off a whole bunch of confused people who are under the assumption tthat the mandate penalty has already been repealed. My suspicions were confirmed by last week's Kaiser Family Foundation survey, which found that sure enough, at least 21% of the country incorrectly thinks that they don't have to pay a fine for not having compliant coverage this year.

House Republicans are demanding a series of controversial abortion and health care policies in the annual health spending bill, setting up a showdown with Democrats and threatening passage of an omnibus spending package to keep the government open.

Democrats are vowing to block the slew of long-sought conservative priorities. The riders would cut off federal funding to Planned Parenthood, eliminate a federal family planning program and ax the Teen Pregnancy Prevention Program, according to sources on Capitol Hill. Republicans also want to insert a new prohibition on funding research that uses human fetal tissue obtained after an abortion.

In nearly a dozen Republican-dominated states, either the governor or conservative legislators are seeking to add work requirements to Obamacare Medicaid expansion, much like an earlier generation pushed for welfare to work.

The move presents a politically acceptable way for conservative states to accept the billions of federal dollars available under Obamacare, bringing health care coverage to millions of low-income people. But to the Obama administration, a work requirement is a non-starter, an unacceptable ideological shift in the 50-year-old Medicaid program and a break with the Affordable Care Act’s mission of expanding health care coverage to all Americans. The Health and Human Services Department has rejected all requests by states to tie Medicaid to work.

The White House is seeking a package of conservative policy concessions — some of which are certain to antagonize Democrats — in return for backing a legislative package bolstering Obamacare markets, according to a document obtained by POLITICO.

The document indicates the administration will support congressional efforts to prop up the wobbly marketplaces, in exchange for significantly expanding short-term health plans and loosening other insurance regulations.

Kreidler announces intention to being rulemaking on short-term medical plans

March 6, 2018

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler announced his intention today to begin rule-making to create protections for Washington consumers who buy short-term medical plans. He is taking this action in response to the recent rules the Trump administration proposed to increase the duration of short-term medical plans from 90 days to up to 364 days.

In a statement last week, Kreidler shared his concerns about short-term medical plans:

RUMFORD, RI (March 6, 2018) – HealthSource RI for Employers today announced it has hit a major milestone. The health insurance marketplace for small employers has now enrolled its 700th small business. These 700 local businesses reflect over 5,200 Rhode Islanders.

U.S. SENATOR TAMMY BALDWIN AIMS TO BLOCK PRESIDENT TRUMP’S PLAN TO ALLOW INSURERS TO SELL JUNK PLANS WITH LEGISLATION TO GUARANTEE PROTECTIONS FOR PRE-EXISTING CONDITIONS

“The Fair Care Act is an opportunity for lawmakers to keep their word on guaranteed protections for pre-existing conditions.”

WASHINGTON, D.C. – Following the Trump Administration’s recent proposed rule allowing insurance companies to once again sell ‘junk’ health care plans, U.S. Senator Tammy Baldwin today announced new legislation to block the rule and guarantee protections for people with pre-existing conditions.

UPDATE: Late last night I was able to dig up the actual legislative text of the bill introduced by the House Democrats yesterday; after reading over the details, I've decided that it's a strong enough package overall that, in software terms, it would be considered a full version upgrade (2.0) as opposed to "only" a service pack/point upgrade (1.5). I've therefore changed the headline to reflect this.

I've also updated some sections fo the analysis below to include the details from the text itself.

“But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”

--Douglas Adams, The Hitchhiker's Guide to the Galaxy

Over a year and a half ago, I noticed that aside from the usual names being listed as insurance carriers offering individual market policies in various states (Humana, Molina, Blue Cross Blue Shield, etc), there was one other name which kept popping up over and over again: "Freedom Life":

Over the past few weeks,I've posted partial 2018 Open Enrollment Period demographic data from Connecticut, Idaho, Maryland, New York and Washington State. Still missing are final wrap-up reports from the other 7 state-based exchanges...as well as The Big One: The official report from the Assistant Secretary for Planning and Evaluation (ASPE).

The 2014 ASPE report was released on May 1st, 2014...just 17 days after the first, tumultuous 2014 Open Enrollment Period ended (only 12 days, really, since the report actually ran through April 19th, 2014 even though the "overtime" period technically ended on April 15th).

Sen. Orrin Hatch (R-UT) on Thursday called supporters of the Affordable Care Actsome “of the stupidest, dumbass people I’ve ever met” during a speech before the American Enterprise Institute.

“We […] finally did away with the individual mandate tax that was established under that wonderful bill called ‘Obamacare,’” Hatch said, according to Fox News 13. “Now, if you didn’t catch on, I was being very sarcastic.”

“[The Affordable Care Act] was the stupidest, dumbass bill that I’ve ever seen. Now, some of you may have loved it. If you do, you are one of the stupidest, dumbass people I’ve ever met. This was one—and there are a lot of ’em up on Capitol Hill from [that] time,” Hatch added.

Matt Whitlock, a spokesman for Hatch, defended the senators comments, telling Fox News 13, “The comments were obviously made in jest, but what’s not a joke is the harm Obamacare has caused for countless Utahns.”

To gauge the perspectives of Americans on the marketplaces, Medicaid, and other health insurance issues, the Commonwealth Fund Affordable Care Act Tracking Survey interviewed a random, nationally representative sample of 2,410 adults ages 19 to 64 between November 2 and December 27, 2017, including 541 people who have marketplace or Medicaid coverage. The findings are compared to prior ACA tracking surveys, the most recent of which was fielded between March and June 2017. The survey research firm SSRS conducted the survey, which has an overall margin of error is +/– 2.7 percentage points at the 95 percent confidence level.

SACRAMENTO, Calif. — Covered California Executive Director Peter V. Lee issued the following statement in connection with the Harvard Medical School Study, “Eliminating the Individual Mandate Penalty in California: Harmful but Non-Fatal Changes in Enrollment and Premiums,”published in Health Affairs. The Harvard study, conducted by a team lead by Dr. John Hsu, is the first national effort to measure the potential impacts of removing the individual mandate penalty based on surveying actual California consumers about their likely actions in the face of there being no penalty.

Millions of people who failed to make sure they were enrolled in ACA-compliant healthcare coverage are going to file their tax returns this spring thinking that they don't have to pay a penalty for not doing so only to discover that the penalty is still in effect.

Then, next spring (assuming the IRS sticks to its guns on the issue and there's no further legislative changes made), anyone who didn't #GetCovered for 2018 are also going to have to pay the penalty (which, again, is either $695 per adult/$348 per child or 2.5% of their household Modified Adjusted Gross Income).

The damage caused by the mandate being repealed to the individual market risk pool (and rate premiums) will be felt this November, when people start shopping around for 2019 coverage...but the actual "benefit" (i.e., those who don't get covered not having to pay the mandate penalty) won't show up until spring 2020.

The Kaiser Family Foundation runs a highly respected monthly national tracking poll on healthcare issues. Their latest was just released, and while there's a bunch of interesting stuff included, there are two main takeaways. Here's the first:

The February Kaiser Health Tracking Poll finds a slight increase in the share of the public who say they have a favorable view of the Affordable Care Act (ACA), from 50 percent in January 2018 to 54 percent this month. This is the highest level of favorability of the ACA measured in more than 80 Kaiser Health Tracking Polls since 2010. This change is largely driven by independents, with more than half (55 percent) now saying they have a favorable opinion of the law compared to 48 percent last month. Large majorities (83 percent) of Democrats continue to view the law favorably (including six in ten who now say they hold a “very favorable” view, up from 48 percent last month) while nearly eight in ten Republicans (78 percent) view the law unfavorably (unchanged from last month).